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Is Abuse of Nerve Pain Drugs Increasing?

The
FDA wants to make sure doctors don’t respond to the opioid epidemic by
over-prescribing another class of addictive drugs—nerve pain drugs advertised
on television.

Known
as gabapentinoids, these drugs, like Pfizer’s Neurontin (gabapentin) and Lyrica
(pregabalin), are approved for a variety of conditions, including postherpetic
neuralgia, fibromyalgia, and neuropathic pain.

Gabapentinoids
can be addictive and prescriptions are on the rise, Kent Runyon, chief strategy
and compliance officer of Novus Medical Detox, a Florida-based drug and alcohol
addiction treatment center, told me. In fact, gabapentin was the 10th most
commonly prescribed medication in the U.S. in 2016, with 64 million
prescriptions dispensed that year, up from 39 million in 2012, according to an
August 2017 article
published in the New England Journal of Medicine.

The
Food and Drug Administration is investigating whether their abuse or misuse is
also increasing and, if so, what should be done to address the problem, FDA
Commissioner Scott Gottlieb said Feb. 15 at a workshop on opioids. Doctors told
me potential actions on these drugs should include more education for
prescribers on their abuse potential and possibly their categorization as
controlled substances.

“It
makes a lot of sense for the FDA to look into it,” Runyon said. Before the
opioid epidemic, opioid prescriptions rose dramatically. “We’re seeing that
same trend now with this medication,” and “that’s certainly a red flag,” he
said.

One
reason for the increase in prescriptions is that doctors are looking for
alternatives to opioids, but “it’s a risk if those alternatives put another
medication into people’s hands that can be abused, can be addictive, or can be
misused by people who are already misusing other medications to get a better
high,” Runyon told me.

“I
think we need to do more with education around this medication” for physicians
on its abuse potential, Runyon said. He also said it makes sense to consider
making gabapentinoids a controlled substance. A controlled substance is a drug
whose manufacture, possession, or use is regulated by the Drug Enforcement
Administration.

But
there’s a concern that making gabapentinoids controlled substances would put
burdens on the patients who need them.

“Less
than 2 percent of people who take a gabapentinoid abuse it” and “to make it a
controlled substance would make the rest of the 98 percent of the patients
taking this medication go through lots of burdens,” Jianguo Cheng,
president-elect of the American Academy of Pain Medicine (AAPM), told me. They
wouldn’t be able to get more than a certain amount of their medication, and they
would be subject to other restrictions, he said. The AAPM, based in Chicago,
represents physicians practicing in the field of pain medicine.

Cheng
said there isn’t sufficient evidence to make gabapentinoids a controlled
substance. Cheng also is a professor and physician at the Cleveland Clinic.

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